Genicular Nerve Versus Adductor Canal Block for Postoperative Analgesia

NCT07588958 | Active Not Recruiting

• 1 other identifier: 10793-14/5-2023
• Study Type: interventional
• Target: 42
• Locations: 1 country
• Sites: 1

Brief Summary

Severe postoperative pain following total knee arthroplasty (TKA ) has been shown to negatively affect early mobilization, physical rehabilitation, time to discharge, and overall post-operative recovery.Therefore, reducing postoperative pain and early mobilization has become critical in reducing early mortality, preventing future chronic pain, and limiting the use of opioids The adductor canal block (ACB) has been found to be an excellent alternative to the FNB, providing adequate analgesia to the anterior knee compartment while enabling an improved postoperative range of motion by sparing motor branches to the quadriceps muscles . However, patients do not achieve adequate posterior knee analgesia as ACB pain relief is primarily limited to the anterior capsule of the knee. Genicular nerve block (GNB) and radiofrequency ablation of genicular nerves (RFGN) were originally introduced by Choi et al. as a therapeutic alternative for chronic knee OA and were quickly adopted for use in patients undergoing TKA due to the significant pain reduction and functional improvement observed in these patients . GNBs target five main innervating branches of the knee, including the superomedial, inferomedial, superolateral, inferolateral genicular nerves, and the infrapatellar branch of the saphenous nerve.

Conditions

Postoperative Pain After Total Knee Arthroplasty

Keywords

genicular nerve block; Adductor canal block; postoperative analgesia; total knee arthroplasty

Outcome Measures

Primary Outcomes (1)

• changes of pain assessment

  visual analogue scale

  time frame ( at PACU, 2 hours (h ) , 4 , 8 , 12 , 16 , 24 hours postoperatively )

Secondary Outcomes (1)

• Modified Bromage scale

  at PACU, 3 hours and 6 hours postoperatively

Study Arms (3)

control group

OTHER

Receive spinal anesthesia

Other: Spinal Anesthesia with Bupivacaine and Fentanyl

Genicular nerve block group

ACTIVE COMPARATOR

Receive Genicular Nerve Block

Other: Genicular nerve block with bupivacaine

Adductor canal block group

ACTIVE COMPARATOR

Receive Adductor canal block

Other: Adductor Canal Block (ACB) Only

Interventions

Spinal Anesthesia with Bupivacaine and Fentanyl OTHER

spinal anesthesia will be given (under complete aseptic conditions) at the level of L3/4 while the patient in the sitting position using a spinal needle 25 G x 3.5 inches with injection of hyperbaric bupivacaine 0.5% 3ml plus fentanyl 25 microgram .

control group

Genicular nerve block with bupivacaine OTHER

For the superomedial genicular nerve, a linear transducer will be placed along the longitudinal plane of the femur to visualize vastus medialis, the distal femur, and the genicular artery. Using an in-plane technique, a 10-cm echogenic 21-gauge needle will be advanced in the cephalad to the caudad direction until the needle contacted femoral shaft, just cephalad to the genicular artery, and 5 ml of 0.25% bupivacaine will be injected to spread along the femoral periosteum. This same technique, using 5 ml of 0.25% bupivacaine, will be used in a mirror image on the lateral epicondyle to block the superolateral genicular nerve. To target the inferomedial genicular nerve, a linear transducer will be placed in the sagittal plane on the anterior medial tibia.

Genicular nerve block group

Adductor Canal Block (ACB) Only OTHER

The transducer will be placed anteromedially midway between inguinal crease and medial condyle to identify sartorius muscle. Probe will be positioned perpendicular to the femoral artery and using in-plane technique with needle directed from lateral to medial to deposit local anesthetic under sartorius and around the femoral artery. 15ml bupivacaine 0.25% will be injected

Adductor canal block group

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• Patient acceptance.
• Sex: both; male and female.
• Age: over 65 years old.
• American society of anesthesiologists (ASA): II .
• Body mass index (BMI) less than 35 kg/m2.
• Operation : elective unilateral TKA.
• Duration of surgery : 2-3 hours.

You may not qualify if:

• History of allergy to local anesthetics (lidocaine or bupivicaine).
• Coexisting hematologic disorders or malnourished patient.
• Pre-existing major organ dysfunction including hepatic or renal failure, and left ventricular ejection fraction \<30%
• Peripheral neuropathy.
• Patients with a diagnosis of cognitive impairment or significant psychiatric illness.
• Skin infection at site of block.
• Contraindication to spinal anesthesia as coagulopathy and infection at site of injection.

Sponsors & Collaborators

• Zagazig University: lead

Study Sites (1)

Faculty of Medicine - Zagazig University

Zagazig, Alsharqia, 4115, Egypt

Location

MeSH Terms

Interventions

Anesthesia, Spinal; Bupivacaine; Fentanyl; Single Person

Intervention Hierarchy (Ancestors)

Anesthesia, Conduction; Anesthesia; Anesthesia and Analgesia; Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines; Piperidines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Marital Status; Family Characteristics; Demography; Population Characteristics; Socioeconomic Factors

Study Officials

• Soha Saad mohamed Hassouna, PHD

  Faculty of medicine - zagazig university

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: double ( participant, outcomes assessor) double-blinded ( participant, outcomes assessor)
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: assistant lecturer of anesthesia and surgical intensive care and pain managment

Study Record Dates

• First Submitted: May 9, 2026
• First Posted: May 15, 2026
• Study Start: October 1, 2023
• Primary Completion: May 6, 2026
• Study Completion (Estimated): June 19, 2026
• Last Updated: May 15, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR
• Time Frame: Planned after completion of the study and publications
• Access Criteria: Contact with principal investigator

Locations

EG (1)